Improving Clinical Services: Be Aware of Fuzzy Connections Between Principles and Strategies PurposeThis article is a response to Alan Kamhi's treatise on improving clinical practices for children with language and learning disorders by focusing on what is known about learning (see Kamhi, 2014, article in this issue).MethodDescriptive methods are used to discuss general learning principles and the fact that they do not ... Clinical Forum
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Clinical Forum  |   April 2014
Improving Clinical Services: Be Aware of Fuzzy Connections Between Principles and Strategies
 
Author Affiliations & Notes
  • Sandra Laing Gillam
    Utah State University, Logan
  • Ronald B. Gillam
    Utah State University, Logan
  • Disclosures: There are two disclosures. First, the two authors of this article developed a program on the basis of their research and funding from the Institute for Educational Sciences (see Gillam, Gillam, & Laing, 2012). Second, the Test of Narrative Language was developed by Ronald B. Gillam (second author).
    Disclosures: There are two disclosures. First, the two authors of this article developed a program on the basis of their research and funding from the Institute for Educational Sciences (see Gillam, Gillam, & Laing, 2012). Second, the Test of Narrative Language was developed by Ronald B. Gillam (second author).×
  • Correspondence to Sandra Laing Gillam: sandi.gillam@usu.edu
  • Editor: Marilyn Nippold
    Editor: Marilyn Nippold×
  • Associate Editor: LaVae Hoffman
    Associate Editor: LaVae Hoffman×
  • © American Speech-Language-Hearing Association
Article Information
Development / School-Based Settings / Language Disorders / Attention, Memory & Executive Functions / Clinical Forum
Clinical Forum   |   April 2014
Improving Clinical Services: Be Aware of Fuzzy Connections Between Principles and Strategies
Language, Speech, and Hearing Services in Schools, April 2014, Vol. 45, 137-144. doi:10.1044/2014_LSHSS-14-0024
History: Received February 28, 2014 , Revised March 7, 2014 , Accepted March 19, 2014
 
Language, Speech, and Hearing Services in Schools, April 2014, Vol. 45, 137-144. doi:10.1044/2014_LSHSS-14-0024
History: Received February 28, 2014; Revised March 7, 2014; Accepted March 19, 2014
Web of Science® Times Cited: 3

PurposeThis article is a response to Alan Kamhi's treatise on improving clinical practices for children with language and learning disorders by focusing on what is known about learning (see Kamhi, 2014, article in this issue).

MethodDescriptive methods are used to discuss general learning principles and the fact that they do not always translate readily into effective language intervention practices. The authors give examples of 2 instances in which popular intervention strategies should have worked but did not. The authors also summarize what they learned about their own approach to contextualized language intervention for teaching priority goals related to narration and the Common Core State Standards (CCSS; National Governors Association Center for Best Practices, & Council of Chief State School Officers, 2010).

ConclusionEven theoretically sound, well-intentioned, and carefully implemented interventions can result in equivocal outcomes. When they do, careful attention to the evidence and willingness to rethink strategy often serves to right the course.

In his article on clinical practices for children with language and learning disorders, which appears as the lead article in this Clinical Forum, Alan Kamhi (2014)  suggests that there may be important gaps between clinical practices and what is known about language learning and language development. Kamhi reminds clinicians of some of the current evidence related to generalization, language models, types of language goals, the distribution of teaching episodes, treatment intensity, and generalization. He suggests that clinicians apply current knowledge of learning and language development to their clinical practice. We agree with Kamhi's basic argument; however, we caution that general learning principles do not always translate readily into effective language intervention practices. Sometimes, therapy activities, even ones that appear to be consistent with one or more well-studied learning principles, do not yield the kind of outcomes that are expected. In making these points, we will remind readers of two instructional strategies, one in reading and one in language, that should have worked but did not. We will also summarize what we have learned about our own approach to contextualized language intervention for teaching priority goals related to narration and the Common Core State Standards (CCSS). Our primary point is that even the most well-intentioned and best-laid plans can sometimes go awry. When they do, careful attention to the evidence and willingness to rethink strategy will sometimes serve to right the course.
The Link Between Learning Principles and Instructional Practice
The relationship between theory and practice is not always clear-cut, and practices that are based on general principles of learning may not always be maximally effective when applied to language instruction or intervention. We have had many discussions with teachers, clinicians, and researchers about an approach to teaching reading called whole language that was popular in the 1980s. The whole language approach was based on a variety of learning principles that were drawn from Piaget's (1974)  genetic epistemology theory, Vygotsky's (1978)  social learning theory, and Peirce's theory of semiotics (Fisch, 1975). There is a great deal of evidence supporting the basic principle that language development occurs as children are actively engaged in sorting out the relationships between signs and their meanings. But, most of the evidence on the ways children construct and use new knowledge did not relate directly to reading instruction. So advocates of whole language adapted a number of learning principles into teaching principles, such as the fact that teachers should provide children with access to print in meaningful contexts that allow them to decontextualize it and recognize how it relates to the language systems that they already know (Goodman, 1979, 1989; Kamii, Manning, & Manning, 1991; Rosenblatt, 1978). Consistent with basic tenets of constructivism, the whole language approach to teaching reading values experiences with and exposure to print over the use of didactic instruction and explicit teaching of phonics.
Whole language gained popularity very quickly and was implemented in a widespread fashion across many school districts in the United States. Over time, a number of large-scale research projects were undertaken to examine the impact of explicit phonics instruction versus whole language instruction that used no phonics instruction or that embedded phonics into ongoing experiences with print (Snow, Burns, & Griffin, 1998). Ultimately, findings showed that reading achievement outcomes were higher when systematic phonics instruction was a component of teaching children to read than when phonics instruction was embedded in print experiences or when there was no systematic instruction in phonics at all. Most educators now agree that balanced literacy instruction that incorporates aspects of systematic phonics together with some whole language strategies for improving reading comprehension results in positive reading outcomes for most children (National Institute of Child Health and Human Development, 2000).
A similar situation occurred in our own field in the late 1990s with the introduction of a computer instruction program called Fast ForWord Language (FFWD; Scientific Learning Corporation, 1998). FFWD was a set of computerized games designed to improve temporal processing and ultimately general language skills for children with language impairment (LI). The program was based on two theories that were supported by compelling evidence: that children with LI often exhibit deficits on auditory temporal-processing tasks (Tallal, 1976; Tallal, Miller, Jenkins, & Merzenich, 1997) and that specialized training can yield changes in the way brains respond to sound (Merzenich & Jenkins, 1995; Recanzone, Schreiner, & Merzenich, 1993). Merzenich, Tallal, Peterson, Miller, and Jenkins (1999)  believed that the application of neuroplasticity-based learning principles to training in auditory processing would result in neural changes that would lead to language gains in children with LI. The neuroplasticity-based learning principles underlying FFWD included daily intensive training and practice, heavy repetition, active attention and responding by the participant, immediate feedback, trial-by-trial response tracking, adapting difficulty levels, and rewarding children for effort and accuracy. Note that relatively few of these learning principles were included in Kamhi's list. Merzenich, Tallal, and their colleagues decided to incorporate those eight learning and teaching principles into their program because there was evidence that activities incorporating those elements resulted in neural change.
A series of studies by the authors of the program suggested that children with LI made remarkable improvements on receptive and expressive measures of language after completing the FFWD exercises (Merzenich et al., 1996; Tallal et al., 1996). Unfortunately, their preliminary findings were not replicated in larger randomized controlled trials (RCTs) conducted by independent research teams. A recent meta-analysis combined the findings of many of these studies and concluded that there was no evidence that FFWD was an effective treatment for children's oral language and reading problems (Strong, Torgerson, Torgerson, & Hulme, 2011). For four of their analyses comparing outcomes of FFWD to untreated controls, pooled effect sizes were quite small (0.079 for passage comprehension, 0.01 for receptive language, and −0.04 for expressive language). There were similarly small pooled effect sizes for comparisons between children who received FFWD and children who received different treatments (−0.026 for passage comprehension, 0.02 for receptive language, and −0.06 for expressive language).
One of the RCTs included in the meta-analysis compared FFWD to two treatments and one active control condition. In that study, all four conditions yielded similar language and auditory processing outcomes for children with LI (Gillam et al., 2008). Four aspects of neuroplasticity-based intervention (highly repetitive stimuli, tracking correct responses, adapting difficulty levels, and use of modified speech stimuli) were part of one or two of the treatment conditions but not all four. Because all four conditions yielded similar improvements, it appears that those four neuroplasticity-based learning principles were not necessary to effect changes in language and auditory processing skills. Gillam and Frome Loeb (2010)  suggested that neural reorganization that promotes language development can result from a variety of intervention procedures that incorporate learning principles such as intensity (e.g., more is better), active attention (e.g., signals to keep children attending), feedback (e.g., information about correctness and effort), and motivation (e.g., praise or tokens).
We have provided just two examples of instructional practices/interventions based on sound learning principles that did not work the way in which they were intended. We now look to an example of a disparity between learning principles and clinical activities that came from our own intervention research.
We agree wholeheartedly with Kamhi's (2014)  assertion that today's speech-language pathologists (SLPs) are faced with an expanded scope of practice that requires a different approach to target selection than in the past. Our approach to language intervention is to target a broad set of skills that are necessary for students to be successful socially and academically and to progress toward attaining the language and narrative skills outlined in the CCSS. Toward that end, we have dedicated a great deal of energy to the design of contextualized intervention programs for teaching discourse-level language skills.
Contextualized Language Intervention
A number of researchers and clinicians have expressed the opinion that contextualized language intervention is superior to decontextualized instruction, and we would be quick to agree. However, a search of the literature reveals that there are very little experimental data to support the use of contextualized language intervention procedures over decontextualized procedures. This is particularly true for studies in which the outcome measure is narrative discourse proficiency. Therefore, we have done something quite similar to what Kamhi has suggested in designing an approach to contextualized language intervention.
In our approach to contextualized language intervention, language targets (vocabulary, morphology, syntax, story grammar) are taught through focused stimulation (Ellis Weismer & Robertson, 2006; Fey, 1984) delivered in the context of meaningful discussions about children's literature. Over the years, we have not changed our basic theoretical orientation that focused stimulation combined with contextualized instruction is superior to decontextualized (direct) instruction. However, we are well aware that not all focused, stimulation-based contextualized intervention approaches result in student outcomes that are large enough to justify the time and expense required to implement them on a wide scale.
We have learned that contextualized language interventions must be carefully designed and monitored to ensure that child outcomes justify the effort and time required to carry them out. To date, we have conducted more than 10 studies of contextualized narrative intervention, six of which we will summarize here. The ultimate goal of this line of research was to design contextualized interventions that teach the narrative comprehension and production skills necessary for attaining the core curricular standards for literacy. For each study, we highlight how we used outcome data to make decisions about whether to revise the instructional strategies or alter the service delivery methods. For brevity's sake and because a few of the studies are in preparation or under review, we will not go into extensive detail about the research methods. It is important to note that, to the extent possible, the testing in each study was administered and scored by research assistants who were blind to group assignment or to the purpose of the project. Here, we present the most relevant aspects of each project to support our position that designing an effective approach to contextualized language instruction requires diligent monitoring and a willingness to revise teaching strategies and dosage. The descriptive aspects of each study are summarized in Table 1.
Table 1.Six studies of contextualized language instruction for children with language impairments.
Six studies of contextualized language instruction for children with language impairments.×
StudyService deliveryDuration/intensityCohen's dCritical elements
1Individual20 min of narration (within 100 min overall), 4 weeks0.41Multiple targets, pictographic planning & parallel story development, literature units, mini-lessons, language facilitation techniques, answering questions, implicit training for SGEs.
2Small group50 min, 6 weeks0.43Multiple targets, pictographic planning & parallel story development, literature units, mini-lessons, language facilitation techniques, answering questions, implicit training for SGEs, experience with oral &written language.
3Small group90 min, 4 weeks1.41Narrative targets (SGEs), pictographic planning & parallel story development, wordless picture books + literature books, language facilitation techniques, answering questions, explicit training for SGEs.
4Whole classroom30 min, 6 weeks0.33Multiple targets (including SGEs), pictographic planning & parallel story development, wordless picture books + literature books, language facilitation techniques, answering questions, explicit training for SGEs, manualized lesson plans and materials.
5Small group35–40 min, 6 weeks1.45No changes.
6IndividualNo changes.
P135 min, 24 sessions, 8 weeks2.54
P235 min, 18 sessions, 7 weeks1.89
P340 min, 22 sessions, 8 weeks0.66
P450 min, 13 sessions, 6 weeks1.35
Note. Italics denote changes to the critical elements of Study 1. SGE = story grammar element; P = participant.
Note. Italics denote changes to the critical elements of Study 1. SGE = story grammar element; P = participant.×
Table 1.Six studies of contextualized language instruction for children with language impairments.
Six studies of contextualized language instruction for children with language impairments.×
StudyService deliveryDuration/intensityCohen's dCritical elements
1Individual20 min of narration (within 100 min overall), 4 weeks0.41Multiple targets, pictographic planning & parallel story development, literature units, mini-lessons, language facilitation techniques, answering questions, implicit training for SGEs.
2Small group50 min, 6 weeks0.43Multiple targets, pictographic planning & parallel story development, literature units, mini-lessons, language facilitation techniques, answering questions, implicit training for SGEs, experience with oral &written language.
3Small group90 min, 4 weeks1.41Narrative targets (SGEs), pictographic planning & parallel story development, wordless picture books + literature books, language facilitation techniques, answering questions, explicit training for SGEs.
4Whole classroom30 min, 6 weeks0.33Multiple targets (including SGEs), pictographic planning & parallel story development, wordless picture books + literature books, language facilitation techniques, answering questions, explicit training for SGEs, manualized lesson plans and materials.
5Small group35–40 min, 6 weeks1.45No changes.
6IndividualNo changes.
P135 min, 24 sessions, 8 weeks2.54
P235 min, 18 sessions, 7 weeks1.89
P340 min, 22 sessions, 8 weeks0.66
P450 min, 13 sessions, 6 weeks1.35
Note. Italics denote changes to the critical elements of Study 1. SGE = story grammar element; P = participant.
Note. Italics denote changes to the critical elements of Study 1. SGE = story grammar element; P = participant.×
×
In Study 1 (Gillam et al., 2008), children with LI were asked to participate in a contextualized language intervention called Individualized Language Intervention (ILI) for 100 min (per session), 5 days per week for 6 weeks. About 20 min of each session were dedicated to narrative instruction; the other time was spent in instruction for multiple language targets such as grammatical morphology, phonological awareness, vocabulary, and complex syntactic constructions. The ILI instruction was structured around children's literature; children were provided with multiple opportunities to talk about and share their knowledge about story content, to use vocabulary and grammatical structures contained in model stories, to answer comprehension questions, and to create their own stories. Instruction in narration was provided implicitly during the course of ongoing discussions; story grammar elements were not taught explicitly. Narrative proficiency was measured with the composite score on the Test of Narrative Language (TNL; Gillam & Pearson, 2004) that combines skill in production and comprehension. There was a moderate effect size for improvement in narration (Cohen's d = 0.41).
In Study 2 (Gillam, Gillam, & Reese, 2012), we used a contextualized language intervention similar to ILI with some alterations that were consistent with traditional models of service delivery in school-based settings. As with ILI, instruction in narration was provided implicitly during the course of ongoing discussions. We decreased the session time from 100 min to 50 min and reduced the number of sessions children attended per week from five to three. We also changed our service delivery model from individual instruction to group (n = 3) instruction. Sixteen children with LI received either our contextualized language instruction (CLI) or decontextualized language instruction (DLI), and their performance was compared to that of a group of eight similar-age children with LI who did not receive any intervention during their summer vacation from school. Both CLI and DLI were associated with improved outcomes for sentence-level measures (recalling and formulating sentences) when compared to the control group. However, only the children in the CLI group demonstrated gains in narrative performance (CLI, d = 0.43, vs. DLI, d = −0.04). Of note, the effect size for improvement in narration was almost exactly the same as in the previous study (ILI, d = 0.41; Gillam et al., 2008), even though children were treated in groups and received much less intervention.
In Study 3, we revised the intervention program in hopes of making a larger impact on narrative language skill. We conducted another nonrandomized comparison study to assess the outcomes of these changes. Changes to the instructional program (highlighted in italics in Table 1) included focusing on narrative structure only (no vocabulary and syntax targets), incorporating wordless picture books as models, and adding lessons designed to teach story grammar elements (SGEs) explicitly as well as implicitly. Additional changes related to the duration and intensity of the intervention: We increased the instructional time in each session from 50 min to 90 min and increased the number of sessions children attended per week from three to four, but we reduced the overall duration of the intervention from 6 to 4 weeks.
Sixteen children between the ages of 5 and 10 were assigned to one of two groups: socialization first (SF) or intervention first (IF). Children in the SF group engaged in free play together for 90 min per day, 4 days each week, for 4 weeks (the control period). After the free-play period, these children received narrative intervention for 4 weeks (the intervention period). The IF group stayed at home and did not receive any services for 4 weeks (the control period), then received our narrative intervention and the free-play condition concurrently, 4 days each week for 4 weeks (the intervention period).
Children were tested immediately after random assignment (pretest), after the month of socialization or individual play at home (midtest), and after intervention (posttest) with the TNL. We hypothesized that staying at home or engaging in free play with other children would serve as within-child control conditions. The standardized effect size for gains in narration was significant and large (Cohen's d = 1.42). We were pleased that the effects of the intervention appeared larger than in our previous studies. However, we were concerned that the intensity and duration requirements were too high for clinicians to be able to implement the intervention in schools. Further, our original perspective on contextualized language instruction was that multiple linguistic targets are best trained within the context of children's literature. We hypothesized from the results of this study that the inclusion of explicit training in story structure (e.g., SGEs) using wordless books may have contributed to the larger gains on our measure of narrative production.
In a series of follow-up studies, we reintroduced the notion of teaching multiple linguistic targets (conjunctions, adverbs, causal and mental state language, vocabulary, and elaborated noun phrases) and added specific instructional modules on SGEs. The instruction was manualized from a series of approximately 10 steps (used in Study 3; see Appendix A) to a set of successive lesson plans for better fidelity and replication of the intervention. Before conducting yet another small-group study with children with LI, we decided to evaluate the intervention in a classroom setting (Gillam, Olszewski, Fargo, & Gillam, in press). In Study 4, instruction was provided to all of the children in one first grade classroom (experimental group) in a Title 1 school by an SLP, three times per week in 30-min sessions for 6 weeks. Children in another classroom (control group) received traditional instruction from their classroom teacher. TNL scores were obtained from all 43 children (experimental group, n = 21; control group, n = 22) before intervention. Children in both groups were designated as typically developing; however, about half scored in the at-risk range (i.e., a standard score of 90 or below, equivalent to the 25th percentile) on the TNL at pretesting (experimental group, M = 72.82; control group, M = 77.75, SD = 10.27). Children in both groups were given the TNL after children in the experimental group received instruction. There was a significant main effect favoring the experimental group for posttest scores on the TNL (d = 0.33). Although this effect size appears small when compared to our previous studies, a systematic review of the effect sizes reported across 176 studies of whole-class instructional activities revealed that the mean effect size was 0.18, with a standard deviation of 0.41 (Lipsey et al., 2012). Thus, for whole-class instruction, our effect size of 0.33 would be considered to be moderately large. The most encouraging outcome of this study was the fact that we were able to incorporate multiple targets into the intervention (including story grammar, vocabulary, and syntax), provide instruction to an entire class of children at fairly low dosage and intensity, and obtain a moderately large effect size.
In Studies 5 and 6, we made no further changes to the instruction, but we varied the service delivery models slightly. In Study 5, we conducted a small-scale RCT with children with LI. Ten children were randomly assigned to receive instruction and 10 continued to receive their traditional speech and language services. Children were seen in groups of three for 35–40 min per session, three times each week for 6 weeks. Our instruction resulted in significant gains on the TNL composite score and was associated with a large effect size (Cohen's d = 1.45).
Finally, Study 6 was designed to assess our intervention's impact on individual children with LI. Six children with LI participated (two sets of three children), with two children in each set receiving intervention and one child remaining in baseline across the entire study. The length of sessions, the number of sessions per week, and the ultimate duration of the instruction differed slightly for each of the four children who received instruction (see Table 1). Our outcome measure was the Monitoring Indicators of Scholarly Language (MISL; Gillam & Gillam, 2013) rubric (sample shown in Appendix B), a tool used to track children's use of SGEs and specific language targets within discourse samples. In a multiple-baseline, across-subjects design, children were asked to tell stories about pictures containing no obvious initiating events during baseline and after each intervention session. These stories were scored using the MISL. Intervention began for the first participant in each set of three children when all participants demonstrated stable baseline performance on the MISL. Once an intervention effect was demonstrated for the first participant in each set, the intervention was implemented with the second participant. This procedure was replicated across two sets of participants; however, due to time constraints, two children remained in baseline throughout the study. We calculated standard mean difference (SMDall) to evaluate the magnitude and strength of the intervention effects (Olive & Smith, 2005). SMDall was calculated from the mean performance data onthe MISL during baseline (all sessions) and intervention (allsessions) and was used to calculate an effect size (Cohen's d) for each participant.
As shown in Table 1, the four participants who received intervention demonstrated moderately large to large effect sizes (≥ 0.8) on the narrative and language targets measured with the MISL. The two participants who remained in baseline demonstrated no measurable improvement in their MISL scores over the course of the study.
We learned from this series of investigations that intervention based on generally accepted teaching and learning principles such as contextualize the targets; modify the environment in ways that motivate the child to use the target forms; model the target forms in functional contexts that encourage meaningful interactions; provide multiple opportunities for children to use the treatment targets; and provide contingent facilitative responses to children's utterances does not always yield the same outcomes. In fact, the effect sizes ranged from moderately small to quite large. Seemingly small adjustments to the treatment activities that were all consistent with the same set of teaching and learning principles resulted in widely different outcomes.
We would like to add one last comment about dosage (session frequency, time spent in session, intervention duration) requirements for bringing about change in various language skills. Research has shown that when clinicians target a discrete skill such as vocabulary, dialogic reading, or print referencing, shorter dosage may be effective in bringing about significant and positive outcomes (Marulis & Neuman, 2010). When the target is a more global goal such as narrative discourse, higher dosage may be necessary to bring about measurable and lasting gains. Ultimately, there does not appear to be a one-to-one relationship between dosage and outcome for most language targets because this must be determined on a case-by-case basis.
Summary
We agree with Kamhi (2014)  that it makes sense for clinicians to approach their clinical practice from a set of theoretically sound teaching and learning principles that match their beliefs about language development. The primary point of our response is that even theoretically sound, well-intentioned, and carefully implemented interventions can result in equivocal outcomes. When they do, careful attention to student outcome data and a willingness to rethink strategy can serve to right the course. The best way to insure that our intervention is effective is to collect data systematically and to be willing to alter our procedures when results fall short of expectations. That sounds like an evidence-based practice model to us, one that fits nicely with Kamhi's suggestions about inserting sound principles of teaching and learning into the gaps between the evidence and practice.
Acknowledgments
Some of the work reported in this article was supported by Institute for Educational Sciences Grant R324A100063, National Institute on Deafness and Other Communication Disorders Grant U01 DC04560-02, and the Lillywhite Endowment at Utah State University. We thank Daphne Hartzheim, Megan Boyle, and Vicki Simonsmeier for their thoughtful input on an earlier version of this article.
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Appendix A
Narrative Language Intervention Procedures (Study 3)
  1. Narrative co-telling from book (with icons). Tell story while also introducing icons. Teach icons with eight-picture story and work on retelling with icons. Place the book and icons (in order) in front of child (or on opaque projector). Create the story with the children. Help children retell the story with icons. Have child place icons on the book in the appropriate place. Emphasize specific targets, for example, macrostructure; two or three specific targets each day per clinician judgment—“focused stimulation on macrostructure.”

  2. Narrative retelling/co-telling (with icons). Pass out icons to children. Practice telling the story as a group, co-tell, then switch icons. Place the book (pictures) in front of the child and distribute icons. Ask the children to retell the story. Have children emphasize their story icon and help each other to fill in their part of the story. Emphasize specific targets: Macrostructure.

  3. Co-telling with five to eight picture sequence cards (with icons). Place the cards and icons (in order) in front of child. Create story with the child. Introduce/use the story grammar icons while creating the story with the child. Have child place icons on the cards in the appropriate place. Emphasize specific targets.

  4. Complex scene story generation: co-telling (with icons). Place complex scene picture and story grammar icons (in order) in front of child. Generate a story with the child using the story grammar icons and picture. Have child place icons on the picture at the appropriate time. Emphasize specific targets.

  5. Story generation: Graphic organizer with pictures (with icons). Have child make up a story using story grammar icons. While child is generating the story, draw pictures on graphic organizer, one picture for each element. Help child with story grammar and emphasize targets.

  6. Clinician-modeled narrative from book (without icons). Tell story to child using book. Emphasize story grammar elements through repetition and factual/inferential questions.

  7. Narrative retelling (without icons). Have child retell story without story grammar icons. Help child. Emphasize targets. If necessary, model story again using story grammar icons while having child help using cloze procedures, inferential and factual questions.

  8. Co-telling with five to eight picture sequence cards (without icons). Same as Step 3, no icons.

  9. Complex scene retelling/co-telling (without icons). Use narrative from Step 4.

  10. Story generation retelling (no pictures, no icons). Same as Step 5, no icons.

Appendix B
Monitoring Indicators of Scholarly Language
Story grammar element0 pointsExample(s)1 pointExample(s)2 pointsExample(s)3 pointsExample(s)
CharacterNo main character identified, or only ambiguous pronouns used. Theywere swimming.At least 1 main character identified using nonspecific labels (pronouns, nouns), with determiner. Thedolphin, A diver, ThatsharkAt least 1 main character identified by name.Annie or BrutusMore than 1 main character identified by name.Annie and Brutus
Salt code = CHIt was too heavy for him.
Note: Only code each character one time.Hestarted to chase.
SettingNo reference to specific place or time.The dolphin was swimming.Reference to general place or time (not related to story).One afternoon1 reference to specific place or time in the story.California ocean,every Monday, or the Jolly Roger2 or more references to specific places and/or times.California ocean, every Monday, the Jolly Roger
Salt code = S
Note: Score of 2 only if specifically stated in the story.
Initiating event (event that motivates/ elicits action, “starts the story”)A problem or “starting” event is not stated.It was wet.At least 1 event or problem that does not motivate/elicit an action from a character.She saw Brutus sneaking up on the diversAt least 1 event that elicits an active response from character(s).Saw Brutus sneaking up on divers + distracts2 or more IEs in 1 story (complex episode).Saw Brutus sneaking up on divers + distracts
Salt code = IEororand
Note: IE must be explicitly stated.Brutus takes off after AnnieBrutus chases Annie + she swam to get awayBrutus chases Annie + she swam to get away
Note. Sample rubric for retell titled “A Dolphin Story.” “Salt code” refers to the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2004) coding procedures.
Note. Sample rubric for retell titled “A Dolphin Story.” “Salt code” refers to the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2004) coding procedures.×
Story grammar element0 pointsExample(s)1 pointExample(s)2 pointsExample(s)3 pointsExample(s)
CharacterNo main character identified, or only ambiguous pronouns used. Theywere swimming.At least 1 main character identified using nonspecific labels (pronouns, nouns), with determiner. Thedolphin, A diver, ThatsharkAt least 1 main character identified by name.Annie or BrutusMore than 1 main character identified by name.Annie and Brutus
Salt code = CHIt was too heavy for him.
Note: Only code each character one time.Hestarted to chase.
SettingNo reference to specific place or time.The dolphin was swimming.Reference to general place or time (not related to story).One afternoon1 reference to specific place or time in the story.California ocean,every Monday, or the Jolly Roger2 or more references to specific places and/or times.California ocean, every Monday, the Jolly Roger
Salt code = S
Note: Score of 2 only if specifically stated in the story.
Initiating event (event that motivates/ elicits action, “starts the story”)A problem or “starting” event is not stated.It was wet.At least 1 event or problem that does not motivate/elicit an action from a character.She saw Brutus sneaking up on the diversAt least 1 event that elicits an active response from character(s).Saw Brutus sneaking up on divers + distracts2 or more IEs in 1 story (complex episode).Saw Brutus sneaking up on divers + distracts
Salt code = IEororand
Note: IE must be explicitly stated.Brutus takes off after AnnieBrutus chases Annie + she swam to get awayBrutus chases Annie + she swam to get away
Note. Sample rubric for retell titled “A Dolphin Story.” “Salt code” refers to the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2004) coding procedures.
Note. Sample rubric for retell titled “A Dolphin Story.” “Salt code” refers to the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2004) coding procedures.×
×
Table 1.Six studies of contextualized language instruction for children with language impairments.
Six studies of contextualized language instruction for children with language impairments.×
StudyService deliveryDuration/intensityCohen's dCritical elements
1Individual20 min of narration (within 100 min overall), 4 weeks0.41Multiple targets, pictographic planning & parallel story development, literature units, mini-lessons, language facilitation techniques, answering questions, implicit training for SGEs.
2Small group50 min, 6 weeks0.43Multiple targets, pictographic planning & parallel story development, literature units, mini-lessons, language facilitation techniques, answering questions, implicit training for SGEs, experience with oral &written language.
3Small group90 min, 4 weeks1.41Narrative targets (SGEs), pictographic planning & parallel story development, wordless picture books + literature books, language facilitation techniques, answering questions, explicit training for SGEs.
4Whole classroom30 min, 6 weeks0.33Multiple targets (including SGEs), pictographic planning & parallel story development, wordless picture books + literature books, language facilitation techniques, answering questions, explicit training for SGEs, manualized lesson plans and materials.
5Small group35–40 min, 6 weeks1.45No changes.
6IndividualNo changes.
P135 min, 24 sessions, 8 weeks2.54
P235 min, 18 sessions, 7 weeks1.89
P340 min, 22 sessions, 8 weeks0.66
P450 min, 13 sessions, 6 weeks1.35
Note. Italics denote changes to the critical elements of Study 1. SGE = story grammar element; P = participant.
Note. Italics denote changes to the critical elements of Study 1. SGE = story grammar element; P = participant.×
Table 1.Six studies of contextualized language instruction for children with language impairments.
Six studies of contextualized language instruction for children with language impairments.×
StudyService deliveryDuration/intensityCohen's dCritical elements
1Individual20 min of narration (within 100 min overall), 4 weeks0.41Multiple targets, pictographic planning & parallel story development, literature units, mini-lessons, language facilitation techniques, answering questions, implicit training for SGEs.
2Small group50 min, 6 weeks0.43Multiple targets, pictographic planning & parallel story development, literature units, mini-lessons, language facilitation techniques, answering questions, implicit training for SGEs, experience with oral &written language.
3Small group90 min, 4 weeks1.41Narrative targets (SGEs), pictographic planning & parallel story development, wordless picture books + literature books, language facilitation techniques, answering questions, explicit training for SGEs.
4Whole classroom30 min, 6 weeks0.33Multiple targets (including SGEs), pictographic planning & parallel story development, wordless picture books + literature books, language facilitation techniques, answering questions, explicit training for SGEs, manualized lesson plans and materials.
5Small group35–40 min, 6 weeks1.45No changes.
6IndividualNo changes.
P135 min, 24 sessions, 8 weeks2.54
P235 min, 18 sessions, 7 weeks1.89
P340 min, 22 sessions, 8 weeks0.66
P450 min, 13 sessions, 6 weeks1.35
Note. Italics denote changes to the critical elements of Study 1. SGE = story grammar element; P = participant.
Note. Italics denote changes to the critical elements of Study 1. SGE = story grammar element; P = participant.×
×
Story grammar element0 pointsExample(s)1 pointExample(s)2 pointsExample(s)3 pointsExample(s)
CharacterNo main character identified, or only ambiguous pronouns used. Theywere swimming.At least 1 main character identified using nonspecific labels (pronouns, nouns), with determiner. Thedolphin, A diver, ThatsharkAt least 1 main character identified by name.Annie or BrutusMore than 1 main character identified by name.Annie and Brutus
Salt code = CHIt was too heavy for him.
Note: Only code each character one time.Hestarted to chase.
SettingNo reference to specific place or time.The dolphin was swimming.Reference to general place or time (not related to story).One afternoon1 reference to specific place or time in the story.California ocean,every Monday, or the Jolly Roger2 or more references to specific places and/or times.California ocean, every Monday, the Jolly Roger
Salt code = S
Note: Score of 2 only if specifically stated in the story.
Initiating event (event that motivates/ elicits action, “starts the story”)A problem or “starting” event is not stated.It was wet.At least 1 event or problem that does not motivate/elicit an action from a character.She saw Brutus sneaking up on the diversAt least 1 event that elicits an active response from character(s).Saw Brutus sneaking up on divers + distracts2 or more IEs in 1 story (complex episode).Saw Brutus sneaking up on divers + distracts
Salt code = IEororand
Note: IE must be explicitly stated.Brutus takes off after AnnieBrutus chases Annie + she swam to get awayBrutus chases Annie + she swam to get away
Note. Sample rubric for retell titled “A Dolphin Story.” “Salt code” refers to the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2004) coding procedures.
Note. Sample rubric for retell titled “A Dolphin Story.” “Salt code” refers to the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2004) coding procedures.×
Story grammar element0 pointsExample(s)1 pointExample(s)2 pointsExample(s)3 pointsExample(s)
CharacterNo main character identified, or only ambiguous pronouns used. Theywere swimming.At least 1 main character identified using nonspecific labels (pronouns, nouns), with determiner. Thedolphin, A diver, ThatsharkAt least 1 main character identified by name.Annie or BrutusMore than 1 main character identified by name.Annie and Brutus
Salt code = CHIt was too heavy for him.
Note: Only code each character one time.Hestarted to chase.
SettingNo reference to specific place or time.The dolphin was swimming.Reference to general place or time (not related to story).One afternoon1 reference to specific place or time in the story.California ocean,every Monday, or the Jolly Roger2 or more references to specific places and/or times.California ocean, every Monday, the Jolly Roger
Salt code = S
Note: Score of 2 only if specifically stated in the story.
Initiating event (event that motivates/ elicits action, “starts the story”)A problem or “starting” event is not stated.It was wet.At least 1 event or problem that does not motivate/elicit an action from a character.She saw Brutus sneaking up on the diversAt least 1 event that elicits an active response from character(s).Saw Brutus sneaking up on divers + distracts2 or more IEs in 1 story (complex episode).Saw Brutus sneaking up on divers + distracts
Salt code = IEororand
Note: IE must be explicitly stated.Brutus takes off after AnnieBrutus chases Annie + she swam to get awayBrutus chases Annie + she swam to get away
Note. Sample rubric for retell titled “A Dolphin Story.” “Salt code” refers to the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2004) coding procedures.
Note. Sample rubric for retell titled “A Dolphin Story.” “Salt code” refers to the Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2004) coding procedures.×
×